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Case Reports
. 2017 Jul 19;3(3):e113-e116.
doi: 10.1055/s-0037-1604075. eCollection 2017 Jul.

Posttraumatic Aneurysm of a Patent Umbilical Vein: Diagnosis and Specific Treatment

Matthias Grade  1 , Siegfried Krishnabhakdi  2 , Thomas Vestring  3 , Micha Löbermann  4 , Joachim Conrad Arnold  5
Affiliations
Case Reports

Posttraumatic Aneurysm of a Patent Umbilical Vein: Diagnosis and Specific Treatment

Matthias Grade et al. Surg J (N Y). .

Abstract

A patent umbilical vein is a rare condition in healthy volunteers, but can be detected in up to 11% of patients with liver cirrhosis as a consequence of portal hypertension. We report the case of a 52-year-old woman who was admitted to our department with acute abdominal pain after blunt trauma to her forehead and abdomen. She had a history of alcohol abuse with liver cirrhosis that had been classified as Child-Pugh stage C 5 years earlier. Signs of portosystemic shunting had been present at an earlier endoscopy, and esophageal varices were found. Clinical examination revealed typical signs of liver cirrhosis, and ultrasound examination showed an aneurysm of 6 cm of the umbilical vein, which had not been present at earlier examinations. After lowering portal hypertension by inserting a transjugular intrahepatic portosystemic shunt, an open surgical resection of the aneurysmal umbilical vein was performed without complications. The patient recovered well and was discharged from the hospital 10 days later. We hypothesize that the abdominal trauma prompted or aggravated umbilical vein aneurysm in this patient with liver cirrhosis and portal hypertension. Due to the risk of rupture, a surgery-based resection is a valuable treatment option.

Keywords: TIPS; liver cirrhosis; patent paraumbilical vein; posttraumatic aneurysm.

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Figures

Fig. 1
Fig. 1
Under ultrasound examination, an echo-poor formation can be identified as a vessel.
Fig. 2
Fig. 2
In the power Doppler mode, the superficial abdominal varices are clearly visible.
Fig. 3
Fig. 3
( a ) Transjugular intrahepatic portosystemic shunt (TIPS) ( b ) Due to the presence of esophageal varices and a patent umbilical vein, a TIPS was implanted before surgical correction commenced to reduce the portovenous pressure and to minimize the risk of intraoperative bleeding.
Fig. 4
Fig. 4
Intraoperative findings. ( a ) The paraumbilical vein patency is ligated but still in situ. ( b ) Typical combined saccular and fusiform-type aneurysm.
See this image and copyright information in PMC

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